疑似宫颈机能不全的保守治疗

Conservative treatment for suspicious cervical insufficiency

超声检测宫颈长度可以辅助诊断宫颈机能不全,但是无统一标准,妊娠中期渐进性无痛性宫颈扩张或缩短为可疑宫颈机能不全,同时伴有早产史或晚期流产史者更符合宫颈机能不全。妊娠中期宫颈长度<25 mm早产风险显著增加,为可疑宫颈机能不全。对于无早产史或晚期流产史者孕妇行环扎术无显著降低早产率的证据,但宫颈长度≤20 mm应用孕酮显著减少了不同孕周的早产率,显著改善了围产儿的结局。对于有早产史或晚期流产史伴宫颈长度<25mm者应用孕酮、环扎和宫颈托均有益处,可据患者意愿和医生的经验选择个体化处理方案。

A widely agreed-upon definition for the diagnosis of cervical insufficiency has yet to be achieved. The advent of ultrasonic cervical length measurement has added an additional criterion to the definition of cervical insufficiency. During the midtrimester of pregnancy the cervical length shorter than 25 mm by vaginal sonography without uterine contraction is suspicious of cervical insufficiency. Cerelage indicated by ultrasound for women with single- ton gestations, no prior preterm birth history is no significant benefit for reduction of the preterm birth rate, however vaginal progesterone, either 90-rag gel or 200-mg suppository, is associated with reduction in PTB and perinatal morbidity and mortality when the CL 〈 20mm. Either vaginal progesterone or cerclage or cervical pessary are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the midtrimester, singleton gestation, and previous preterm birth history. The selection of the optimal treatment may depend upon adverse events, cost and patient/clinician preferences.